Issue Editor Foreword
Considering Principles of Learning
in the Treatment of Acquired
Communication Disorders
This issue considers principles of learning in the
treatment of acquired communication disorders,
specifically incorporating a study that examines
intervention for adolescents with acquired brain
injury and four studies that examine principles
of learning as they apply to aphasia. The
predominance of articles on learning in aphasia
represents a bit of a shift, as traditionally work in
aphasia has focused on characterizing the
language deficits that define and are central to
aphasia and on evaluating the effectiveness of
interventions for aphasia. Increasingly, however,
studies are identifying the presence of cognitive
deficits in aphasia (see Lesniak, Bak, Czepiel,
Seniow, & Czlonkowska, 2008 for review) and the
potential influence this may have on an individual
with aphasia’s interaction with and progress with
therapy.
Learning, defined as “knowledge or skill
acquired by instruction or study” (Merriam
Webster Dictionary, n.d.), is central to the process
of rehabilitation (Hopper & Holland, 2005).
Rehabilitation aims to bring about a reduction of
impairments and/or improvement in function
through instruction, practice, education, and the
development of strategies. Therefore, although
not the core deficit in communication disorders,
learning is a critical component for developing
tailored intervention approaches that can target
goals while utilizing appropriate supporting
cognitive networks and skills.
LEARNING WAYS TO RETURN TO LEARN
The first article of this special issue is the report
of a case series analysis of therapy practices
The author has indicated that she has no financial and
no nonfinancial relationships to disclose.
DOI: 10.1097/TLD.0000000000000210
3
Copyright © 2020 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
carried out by speech–language pathologists
within multidisciplinary teams caring for
adolescents experiencing prolonged concussive
syndrome (PCS). Wright, Sohlberg, Watson-Stites,
and McCart (2020) report on the number and
types of incidents associated with PCS in
adolescents, they outline methods of intervention
utilized to address academic goals for students,
and consider the relative effectiveness of
categories of interventions. The article addresses
learning from two perspectives: (1) the return
to learning as a goal, and (2) learning as an
integral component of cognitive rehabilitation
strategies.
Guidelines for treatment following concussion
are predominantly position statements or
descriptions of unique implementations models.
Authors present the current work as a means of
examining existing cases and building foundations
upon which future empirical studies can be
designed to evaluate the effectiveness of cognitive
rehabilitation interventions.
PRACTICE SCHEDULES OF LEARNING
In a review article, Middleton, Shuchard, and
Rawson (2020) report on a body of psychological
research that has examined how practice
schedules influence rates and retention of new
knowledge. In the first part of the review, the
authors identify four key principles of practice
schedules that have been repeatedly identified as
meaningful to promote long-term retention of
learning in participants without neurological
insult:
1. Item repetition—in succession (massed)
versus after intervening trials (spaced):
Separating trial repetitions with more than
one intervening trial enhances long-term
retention of learning.
2. Item lag: In a spaced practice schedule,
longer lags between trial repetitions
 promote greater long-term retention of
learning.
3. Item distribution—within session versus
across session: Training items across two
sessions rather than within a single session
promotes long-term retention of learning.
4. Session lag: Longer lags between sessions
promote greater long-term retention of
learning.
In the second part of the review, authors
examine results from research involving
individuals with aphasia that manipulates
principles of distributed practice in studies
evaluating the effectiveness of naming and
language interventions. This review brings forth
interesting and important clinical implications for
therapy. Although in current practice
speech–language pathologists work closely with
individuals with aphasia to determine the targets
of therapy and the approaches to be used,
minimal attention is paid to details such as the
spacing of repeated trials and lag between
sessions. In a clinical context where therapy
sessions are often limited, any application of
principles that can enhance the improvements
brought about through therapy should be
considered and incorporated when possible.
PRIMING IN APHASIA
The next article in the issue is the report of an
experimental study that examines priming
behaviors in individuals with aphasia and
controls. Silkes, Baker, and Love (2020) examine
priming effects—whether a participant responds
faster to a target that is preceded by a related
stimulus (prime) than when preceded by an
unrelated stimulus—under a variety of
prime–target conditions. Authors manipulated the
time interval between prime and target and also
manipulated the linguistic load of targets (e.g.,
words vs. shapes), with the goal of better
understanding priming in aphasia.
This study brings forth the important notion
that learning can be carried out consciously or
without conscious awareness. Much of conscious
learning depends upon reasoning, hypothesis
testing, and feedback processing, which may
draw upon language and thus be impacted by
language impairments. Learning that is carried out
without conscious awareness does not depend
Copyright © 2020 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
upon language and has been explored as an
avenue to support aphasia intervention.
WORD LEARNING IN APHASIA
In contrast to priming, which is considered
implicit and as occurring below conscious
awareness, in most instances of learning, the
learner is aware that learning is the goal or is
taking place. Coran, Rodriguez-Fornells,
Ramos-Escobar, Martin, and Laine (2020) report
on a word-learning paradigm carried out with
conscious intention by individuals with aphasia.
Over the course of 4 weeks, individuals with
aphasia engaged in two weekly hours of training
in which they learned to recognize and repeat
target names associated with images. Authors
probe the novel hypothesis that repeated practice
with learning will lead to associated
improvements in verbal short-term memory,
evaluating learning results as they relate to
cognitive–linguistic and memory measures.
Authors additionally examine the structural
integrity of the arcuate fasciculus to gain insights
into the relationship between the integrity of the
dorsal language pathway and word learning in
aphasia.
Study results suggest that verbal short-term
memory improves as a result of repeated novel
word-learning practice, demonstrating that
learning is not only a vehicle for therapy but that
the act of learning can bring about cognitive
change.
ATTENTIONAL ALLOCATION DURING
LEARNING IN APHASIA
Finally, Vallila-Rohter and Czupryna (2020)
report on an experimental study that utilizes eye
tracking to examine attentional allocation during
category learning in a group of individuals with
aphasia and age-matched controls. Research has
documented the presence of deficits in attention
in individuals with aphasia relative to controls
(e.g., Murray, 2012; Peach, Newhoff, & Rubin,
1993; Villard & Kiran, 2015) and prior work in
category learning has identified reduced learning
ability in individuals with aphasia (Vallila-Rohter &
Kiran, 2013, 2015). Authors aimed to examine
patterns of visual attention during learning to gain
insights into the process of learning.
 Stimulus animals comprised four features, each
predicting category membership with a different
degree of reliability (77% vs. 55% of trials). Prior
studies using this task (Rehder & Hoffman, 2005)
have demonstrated that through the course of
learning, participants adjust their attentional
allocation, focusing only on features that are
highly predictive of category membership be the
end of training. Findings suggest that older adults
and individuals with aphasia may have difficulty
inhibiting visual distractors and/or shifting visual
attention drawing attention to the importance of
considering the visual demands of materials
presented in therapy.
Together, this collection of articles touches
upon manipulations to contexts of learning that
can contribute to variable success with learning
and long-term retention of information. There are
many more variables of learning (e.g., further
manipulations of schedule and intensity,
additional methods of implicit and explicit
instruction, and modality and timing of feedback
presentation) that can impact learning outcomes.
Given that learning is central to the process of
rehabilitation, individualizing intervention
approaches for individuals with communication
disorders likely depends upon evaluations of the
strength and weakness of the language system,
considerations of functional goals, and also on
evaluations of learning and additional cognitive
systems that are recruited in the process of
rehabilitation that enable and support
intervention. Understanding these principles is
essential to developing, selecting, and carrying
out interventions in ways that will promote
maximal gains for individuals with
communication disorders.
—Sofia Vallila-Rohter, PhD, CCC-SLP
MGH Institute of Health Professions
Boston, Massachusetts
svallilarohter@mghihp.edu
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Hopper, T., & Holland, A. L. (2005). Aphasia and
learning in adults: Key concepts and clinical
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Copyright © 2020 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.
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